Open Heart: A Patient's Story of Life-Saving Medicine and Life-Giving Friendship [NOOK Book]

Overview

When Neugeboren discovered he needed emergency quintuple bypass surgery, he embarked on a journey that just began with the operating table.
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Open Heart: A Patient's Story of Life-Saving Medicine and Life-Giving Friendship

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Overview

When Neugeboren discovered he needed emergency quintuple bypass surgery, he embarked on a journey that just began with the operating table.
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Editorial Reviews

Publishers Weekly
Neugeboren, a 60-year-old writer (Imagining Robert), had assumed that he was in great physical shape without risk factors for heart disease. When he experienced shortness of breath and pain between his shoulder blades, these symptoms did not alarm his personal physician. However, after several lengthy cross-country telephone conversations with Rich, a Brooklyn high school friend and cardiologist living in California, it became clear that Neugeboren had a serious coronary disease and Rich insisted that he be hospitalized immediately. With the help of three other high school buddies, Jerry, Arthur and Phil, all prominent physicians, Rich guided Neugeboren through the process of bypass surgery, performed in the nick of time. In addition to his successful operation, Neugeboren credits the support and love he received from these four men with saving his life. This well-crafted and expressive memoir recounts the extensive conversations Neugeboren held separately with his physician friends after he recovered. Deeply committed and working in different fields of medicine, these doctors describe the frustrations inherent in managed care that cause them to rely so heavily on technology and testing rather than spending time listening to and learning from their patients. In the end, Neugeboren, convinced that the patient will provide the diagnosis if the doctor listens, presents a thoughtful rumination on the art of diagnosis and healing. (Aug.) Copyright 2003 Reed Business Information.
Library Journal
Neugeboren (Transforming Madness; Imagining Robert) was an apparently healthy 60-year-old who swam a mile a day and regularly played basketball. When he went in for a routine checkup in 1999, the doctor ordered an angiography. To the author's shock, the results revealed that he had probably suffered a heart attack and that his four blocked arteries required emergency bypass surgery. The following day, Neugeboren underwent a quintuple bypass. This memoir of his diagnosis and recovery includes lengthy excerpts from his journals; describes the help and support of four lifelong friends, all of whom are doctors; and examines the practice of medicine, ending with an eloquent plea to doctors to see patients as individuals and not just as conditions or diseases. In addition, there are reflections from his friends on their lives as physicians. Neugeboren discovers that, while medicine can control symptoms and disease progression, much is still unknown about underlying causes. Recommended for larger consumer health collections.-Jodith Janes, Cleveland Clinic Foundation Lib. Copyright 2003 Reed Business Information.
Kirkus Reviews
What begins as a memoir of one man's encounter with modern medicine expands into contemplation of the state of health care today. Neugeboren (Transforming Madness, 1999, etc.) was told in 1999 that his coronary arteries were nearly 100 percent blocked and that he must immediately undergo bypass surgery. Fortunately, four of his close friends-Rich, a cardiologist; Phil, a neurologist; Jerry, an AIDS doctor; and Arthur, a psychologist-shepherded him through this crisis, making sure he got the best of care. Reflecting on the experience afterward, he concluded that while his surgical procedure depended on high technology, what made the difference between life and death was decidedly low-tech. His successful outcome, he asserts, was due in large part to the fact that he received the attention of doctors who knew him and listened to him. His opinion was confirmed about a year later when consulting two reputable New York urologists. The first never connected with him as a human being; the second paid attention to his concerns and answered his questions. For Neugeboren, who left the second doctor's office feeling reassured and relieved even though this physician's assessment of his condition was more serious, the crucial difference was that the first doctor practiced the impersonal science of medicine, while the second combined science with the art of medicine. That art, he warns, is often missing for many of us in our encounters with modern medicine. The author includes numerous excerpts from his own journals and long quotes from conversations with his four closely involved friends, who discuss not only the author's particular case but the state of medicine today, how they came to choose theirprofessions, and what they think about their work. In his examination of the healing arts, Neugeboren also draws on the books of numerous other thoughtful writers on medical matters, including Lewis Thomas, Sherwin Nuland, Gerald Grob, and Daniel Callahan. A skillful blending of personal experience and public concerns.
From the Publisher
"A skillful blending of personal experience and public concerns." Kirkus Reviews

"This memoir...is strongest as a testimonial to friendship." Boston Globe

"In this inspiring book, Neugeboren thoughtfully recounts his emerency bypass sugery and ruminates on the state of doctor-patient relationships..." Ploughshares

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Product Details

  • ISBN-13: 9781497669444
  • Publisher: Dzanc Books
  • Publication date: 7/8/2014
  • Sold by: Barnes & Noble
  • Format: eBook
  • Pages: 370
  • File size: 820 KB

Meet the Author

Jay Neugeboren is the author of 18 books, including two prize-winning novels (The Stolen Jew and Before My Life Began), two prize-winning books of non-fiction (Imagining Robert: My Brother, Madness, and Survival and Transforming Madness: New Lives for People Living with Mental Illness), and four collections of award-winning stories. His most recent novel, 1940, was long-listed for the International IMPAC Dublin Literary Award. Two new novels are scheduled for publication: The Other Side of the World, Fall 2012, and The American Sun & Wind Moving Picture Company, Spring 2013.

His stories and essays have appeared widely (in the New York Review of Books, the Atlantic Monthly, the American Scholar, the New York TimesGQNewsweekMidstreamHadassahSport, the Gettysburg ReviewPloughshares, Authors Guild Bulletin, etc.), and have been reprinted in more than 50 anthologies, including Best American Short Stories and The O. Henry Prize Stories.

His screenplay for The Hollow Boy, which premiered on American Playhouse, has won many honors, including top prize at the Houston International Film Festival. An award winning documentary film based on Imagining Robert, in which he co-starred with his brother, and for which he wrote the script, has been appearing nationally on PBS stations since 2004. He is the recipient of numerous other awards, including fellowships from the Guggenheim Foundation, the National Endowment for the Arts, and the Massachusetts Council on the Arts, and is the only author to have won six consecutive Syndicated Fiction Prizes. His archive is housed at the Harry Ransom Humanities Center in Austin, Texas.

He has given Grand Rounds at Harvard Medical School, Yale Medical School, North Shore Hospital, Bay State Medical Center, Roosevelt-St. Luke’s Hospital, and other medical facilities, and has been keynote speaker nationally and internationally for numerous mental health organizations, including the U.S. Department of Health and Human Services. He has also served as a consultant to the World Health Organization.

Mr. Neugeboren was Professor and Writer-in-Residence for many years at the University of Massachusetts at Amherst, and has taught at other universities, including Stanford, Indiana, SUNY at Old Westbury, and Freiburg (Germany). He now lives and writes in New York City, where he is on the faculty of the Writing Program of the Graduate School of the Arts at Columbia University.
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Read an Excerpt

1
How Little We Know

On an unseasonably mild, sunny afternoon in early February 1999, I drive
down from my home in Northampton, Massachusetts, to Guilford,
Connecticut, 120 miles away, to spend an evening with my friend Jerry
Friedland and his wife, Gail. Jerry is director of the AIDS programs at Yale–
New Haven Hospital and the Yale School of Medicine, and he and I have
known each other for nearly fifty years — since the fall of 1952, when we
were both sophomores at Erasmus Hall High School in Brooklyn.

Early the next morning I leave my car at Jerry's house and we
head in to Yale–New Haven Hospital together. As I have also been doing for
the past dozen or so years with another high school friend, Phil Yarnell, a
neurologist living in Denver, Colorado, I take a break once or twice a year
from my own work — my writing and teaching — to spend a day with Jerry
at his work.
This time, however, I am traveling with Jerry to New Haven not to
spend a day with him at the hospital and in his AIDS clinic, but because he
has helped arrange an appointment for me with Dr. Henry Cabin, chief of
cardiology at the hospital, to see what's going on in my heart. Dr. Cabin,
who will take an angiogram of my coronary arteries (injecting radio-opaque
dye that makes blockages visible when x-ray pictures are taken), has told
me that this is ordinarily an outpatient procedure. Even if he finds significant
blockages and decides to perform angioplasty (threading balloons into one
or more of my coronary arteries through a catheter to open the arteries), I
should be able to driveback to Massachusetts following the procedure.
Still, Jerry has insisted that I return home with him afterward and stay
another night so I can rest up, and so we can have more time together.
Being with Jerry while he works with patients, staff, and medical
students and talking with him about his work have given me great pleasure
through the years — have inspired me, really. Jerry is one of my oldest and
dearest friends; he is also a doctor whose work with AIDS patients and
AIDS research has been literally life-changing and life-saving for thousands of
people.
When we spend time together between my visits to Yale–New
Haven, we continue the dialogues begun there — discussing patients I've
met and how they're doing, talking about his AIDS research and his public
health projects, and — as in my ongoing talks with Phil — moving from the
particular to the abstract and back again while speculating on the causes,
prevention, diagnosis, and treatment of disease in general — about where,
in things medical, we've been, about where we are, and about where we
might be going.
Also, a true joy, knowing each other as we do across most of our
lives, our talks have meandered — inevitably, always — along more
personal paths as, without needing to impress or dissemble, we've tried, in
matters having to do with things more private — family and friends, above
all — to understand just who we've been, who we are, and where we might, in
the years ahead, be going. When we are together, the time between visits —
whether days, months, or years — disappears. Our conversations, at sixty,
are as warm and stimulating — as rich, delightful, and filled with laughter —
as were our conversations nearly a half century ago when we were
teenagers taking walks together along Flatbush Avenue in Brooklyn.
At the hospital, Jerry walks me through admissions, and,
although he regularly puts in seventy-to-eighty-hour workweeks (Gail
maintains this is a very low estimate), he seems to have nothing else to do
but to be with me, and he stays with me until I am in the room where the
angiography is to be performed. Later on he will recall how astonished he
was to find that when I undressed to ready myself for the procedure, I had to
roll up my clothes and place them on the floor in a corner of the room. If I
hadn't been his friend, he said, he might not have noticed, and this was a
reminder to him of how different things often seem, and are, from a patient's
perspective.
When I wake from anesthesia a few hours later, I'm lying on a
gurney, and Dr. Cabin is smiling down at me. Although Dr. Cabin is a
decade or so younger than we are, he too grew up in Brooklyn, where both
his parents were high school teachers, and this, along with his warm, direct
manner, puts me at ease. He has straight dark brown hair, is about
five-foot-nine — two inches taller than me — and is fit and athletic-looking. I
look up at him, my head a bit woozy, and he looks familiar suddenly, like one
of the guys I played schoolyard ball with in Brooklyn.
"Let me show you what we found," he says.
He points to a monitor hanging above me and explains that what I
am seeing is film from the x-rays taken of my heart. The lines of colored
fluid moving downward and outlining my coronary arteries — bourbon-colored
squiggles, in my memory — come from the dye injected through a catheter
he had inserted into the femoral artery in my groin.
On the screen I watch blood begin to flow into each of my three
major coronary arteries, then stop. Dr. Cabin points to the spot where only
a small amount of fluid continues to leak downward and says the angiogram
tells us that only one of my three major coronary arteries is working and
that no more than 10 percent of that artery is functional. Two of my three
major coronary arteries (the right coronary artery and the circumflex artery)
are 100 percent blocked, the third (the left anterior descending artery) 90
percent.
Dr. Cabin estimates my ejection fraction, which measures the
heart's ability to pump blood and which is the best general indicator of the
heart's overall functioning, at 30 to 35 percent; in a healthy heart, it would
be between 50 and 70 percent.
"You've been going on nothing," Dr. Cabin says to me, and
then: "We're going to try to get you into surgery tomorrow morning."
"Great," I say without missing a beat, and it is only later that Jerry
makes me aware that my reaction — Hey, this is good news, so let's go for
it and do whatever we have to — is not typical. At the same time, I am, if
optimistically, in a daze. I hear everything Dr. Cabin says to me but still
seem to believe that in an hour or so I'll walk out of the hospital with Jerry,
get into his car, and drive back to Guilford. Instead of spending an evening
with Jerry, however, I may instead — the possibility seems an ordinary
piece of information — get to spend my last evening on earth alone in a
hospital room in New Haven.
Dr. Cabin tells me that because the arterial occlusions are so
massive, I am going to need a quadruple coronary bypass. (Like a bypass
that reroutes cars and trucks around an avenue clogged with traffic, a
coronary bypass graft, stitched in above and below an obstructed artery,
reroutes blood through an unclogged artery and around the obstructed
artery.) He tells me that he is putting me on several medications to
minimize the possibility of a heart attack, that he has already conferred with
Jerry about surgery, and that he has put a call in to Dr. Sabet Hashim, the
man he and Jerry consider the best cardiovascular surgeon at Yale. If Dr.
Hashim cannot arrange to operate the following morning, a Friday, I will stay
in the hospital over the weekend so that Dr. Cabin and his staff can keep an
eye on me. The slightest exertion — or no exertion at all — might cause
some arterial plaque to flake off, or to rupture, and block the narrow portion of
my one coronary artery that is still working.
Open-heart surgery (or, more accurately, open-chest surgery) is, I
know, a major event, a procedure that seems as astonishingly primitive as
it is technically remarkable: They will crack open my chest then slice open
an arm and a leg to harvest a vein and an artery that, after they shut down
my heart for several hours while recycling my blood through a heart-lung
machine, they will stitch into my heart before reattaching major incoming
and outgoing arteries, jumpstarting my heart with electricity, and stapling and
sewing my chest closed. Even though I will be virtually dead for several
hours — my body temperature lowered to 80 degrees (as with hibernating
animals, cooling reduces the body's need for oxygen, thereby giving the
surgeon extra time for suturing) while a team of doctors and technicians
retrofit me with new interior plumbing made up of spare parts taken from
within my own body — the procedure itself, for all the drama and miracle of
the fact that one can perform it on living human beings, has become
commonplace. Hundreds of thousands of bypasses are performed each
year (more than a half million in the United States), and — given my state of
health — the possibility of failure, error, or distressing side effects seems
minimal.
Dr. Cabin talks with me about the surgery, and I ask if he was
surprised to discover that my arteries are nearly 100 percent blocked.
"No. Little in my line of work surprises me," he says, and he
adds — something he will repeat when I see him for a six-week checkup
following surgery — "But you are totally anomalous."
True enough, I think, for despite the extent of the blockage, I have
had few of the symptoms that usually accompany severe coronary disease:
no chest pain or discomfort (no heaviness, pressure, tightness, or
squeezing sensation), and no arm pain, dizziness, nausea, palpitations,
faintness, or unusual fatigue. Luckier still, especially given the magnitude of
the blockage, I do not seem, on the evidence of an echocardiogram, to have
had a heart attack.
Nor do I seem to have had any of the classic risk factors for
coronary disease. Until a week or so before surgery, I was swimming a mile
a day, and at a good pace, as I had been doing for the previous twenty-five
years, while also regularly playing tennis and half- and full-court basketball
(sometimes with teenagers). I had never been a smoker, my cholesterol
was normal, and so was my blood pressure.
My resting pulse was fifty-eight. By all accounts I was in excellent
physical shape and, at five-foot-seven and 150 pounds, I weighed perhaps 5
pounds more than I had forty-four years before when I was a senior in high
school.
Genetics and family history? My mother was still alive at the age
of eighty-seven, most of my thirteen aunts and uncles had lived well into
their eighties, and some had survived into their nineties. My father, who died
of emphysema at the age of seventy-two, had had a heart attack when he
was fifty-nine, but he never exercised, had been overweight, and had smoked
three packs of Chesterfields a day throughout his adult life.
About an hour after my talk with Dr. Cabin, when I've been moved
to a hospital room and am lying in bed — the first time I've been
hospitalized since I was operated on for Hodgkin's disease at the age of
eighteen, forty-two years earlier — Jerry comes by to visit.
"Hey Neugie," he says, using the nickname all my old friends
use. "How're you feeling?"
I tell him I'm feeling a little groggy, and very lucky — lucky they
found what they found and that, as I've just learned, they can get me into
surgery in the morning. (Later, Jerry and Gail tell me they felt lucky too,
since Dr. Cabin had suggested that if Dr. Hashim was unable to perform the
surgery on Friday they might take me home for the weekend. "Oh my God
— what do I remember about CPR?" Gail, a registered nurse, asked Jerry
when he told her of this possibility.)
Jerry tells me that after Dr. Cabin saw the results of the
angiography, he had paged Jerry and they had discussed what to do next.
Jerry says that he was surprised — very much so — at what the angiogram
revealed, but that he is pleased to learn that Dr. Hashim will be performing
the surgery in the morning. The sooner the better, he says, and he tells me
that my swimming and being in such good shape have probably saved my
life.
"It seems you've been living on your collaterals," Jerry says, and
he explains that the collateral blood vessels I'd probably developed by
swimming a mile a day for the past twenty-five years — hundreds of small
steady-state blood vessels that lie between and connect the coronary
arteries and that cannot expand and contract the way coronary arteries
can — had been supplying the blood and oxygen to my heart and lungs
that my coronary arteries were no longer providing.
Jerry then describes what he saw on the monitor. "A second or
two after the blood stopped flowing into your heart, the entire bottom of the
TV screen — the lower part of your heart — lit up, just blossomed with the
glow of all those collateral blood vessels," he says. "It was an amazing
sight."
We talk about telling my three children about the surgery, and
this gives me pause — unsettles me for the first time since I arrived at the
hospital. For a full half minute or more I cannot speak. Jerry smiles down at
me. He is a strikingly handsome man, five-foot-eleven and about two
hundred pounds, with a trim silver beard, a full and wavy shock of silver hair,
and penetrating gray eyes that remind me of Jewish actors such as John
Garfield and Paul Newman who have had the same captivating mix, in their
looks, of toughness, intelligence, savvy, and tenderness. When, seeing my
reaction, Jerry puts his hand on top of mine, I melt. Is this it? I wonder. Is the
big basketball in the sky really about to fall on me?
Although Jerry's presence comforts, it is also sobering, since he
does not hide the seriousness of his concern, and when he asks if I would
like him to call my children, I shake my head sideways and see myself, a
small boy again, sitting on the floor of my office at home, sorting through
my baseball cards and glancing up now and then toward my desk, where the
light is on but nobody is working.
For more than a dozen years, I have been a single parent to my
three children. By this time, however, the last of my children having left
home the previous spring, I am, for the first time in three decades, no longer
an on-site single parent. All three have graduated from college and are living
on their own: Miriam, at twenty-nine, in the Washington, D.C., area; Aaron,
at twenty-six, in Northampton; and Eli, at twenty-four, in Brooklyn, not far
from where I was born and from where Jerry and I grew up.
I had told each of my children about driving down to New Haven for
the angiogram but, not wanting to alarm or burden them, had minimized its
importance: everything seemed fine, I'd said, and I was still swimming a
mile a day, but some anomalies had shown up on an electrocardiogram, and
we thought it best to check things out further, so I'd decided to have an
angiogram performed at Yale–New Haven. That way, I explained, I could
also spend some time with Jerry.
When I find my voice, I tell Jerry that I'll telephone my children.
Jerry says that he'll call them also and that they can stay at his house (into
which he and Gail moved two weeks before) for as long as they want.
Jerry also tells me he's spoken with Rich Helfant and that Rich
agrees about the need for emergency bypass surgery. Rich, too, is an old
high school friend, and I've known him even longer than I've known Jerry,
since, starting from a time when we were seven or eight years old, Rich and
I went to the same Hebrew School (we later played together on our
synagogue's basketball team). Rich is a cardiologist now living in California
— most recently he served as chief of cardiology at Cedars–Sinai Medical
Center in Los Angeles; before that he was director of the Philadelphia Heart
Institute and chief of medicine and cardiology at Presbyterian-University of
Pennsylvania Medical Center — and these past few weeks he and I have
been talking nearly every day. In the week to ten days preceding the
angiogram, a fact I found both welcome and disquieting, he had been calling
me several times each day.
Later that afternoon Rich calls and says he is not at all surprised
at what the angiogram revealed and that, based on his talks with Jerry, he
has every confidence in Dr.Hashim and the people at Yale. He reminds me
that he had been urging me into the hospital — gently, gently, so as not to
scare me — for several weeks.
When my family practitioner, while not excluding the possibility of
coronary disease, thought the symptoms that had made me call for an
appointment — some occasional shortness of breath while swimming —
were due to adult-onset or exercise-induced asthma, and when a local
cardiologist, finding some anomalies in an electrocardiogram and an
echocardiogram, while also not excluding coronary disease, thought the
problem was probably viral, Rich had exploded. "It's not viral, goddamnit!" he
had exclaimed, in the first burst of exasperation I'd heard from him since I'd
begun talking with him about my concerns. "I want you in the hospital as
soon as possible."
The local cardiologist had recommended that I have an angiogram
done at Bay State Hospital in Springfield, but when I called his office to
make an appointment, the colleague who performed the angiograms was
booked for several weeks. I was persistent and secured a "brief office visit" a
week later, not for the angiogram, but to confer about setting up an
appointment for the angiogram. Then I had telephoned Rich, Jerry, and Phil.
"Listen," I'd said to Rich, as I had to Jerry the day after I'd
received the results of the EKG and the echocardiogram, "why don't you
guys all talk with one another and then just tell me what to do?"
On Sunday morning, Jerry phoned to say that he and Rich had
decided I should come down to Yale and that Dr. Cabin would be calling me
at home (as he did) to arrange for the angiogram.
Now, less than a week later, Rich says that, barring the
unforeseen, he feels certain that the bypass surgery and the recovery from
the surgery will go swiftly and smoothly. He asks about my children, and I
tell him I've spoken with each of them and that they will all be arriving at the
hospital before surgery the next morning.
Aaron is already on his way down from Northampton by bus; Eli is
on his way from New York City by train; and Miriam and her fiancé Seth will
be taking a three a.m. train from Washington, D.C., and will arrive early the
next morning. I tell Rich I was surprised that they didn't hesitate, and will be
with me — I note that I didn't ask any of them to come — and Rich tells me
he is surprised that I was surprised. Why wouldn't my children want to be
with me at a time like this?
After supper, Dr. Hashim stops by and talks with me for a while.
Dr. Hashim is Lebanese and therefore, I expect, speaks French. I tell him I
lived in France for two years some thirty years ago, before and after my first
child, Miriam, was born, and Dr. Hashim and I proceed to talk with each
other in both French and English. Although he describes the surgery and
explains the possible risks attendant to it, such as stroke, retinal damage,
cognitive losses, and infection, and says that, given the excellent state of my
health, he sees no cause for concern, it is our conversation about things
ordinary and familial that calms my fears and reassures.
When I comment on his name and its possible biblical origin, he
tells me that yes, he believes he is a descendant of families that inhabited
the ancient Hashemite kingdom. He asks about my name and I tell him my
father's family came from Ryminov, a shtetl in the Carpathian Mountains —
from a region now part of Ukraine — and that they had been in the
butter-and-egg business there, as they were after they came to the United
States. When, in the Austro-Hungarian Empire, civil servants assigned family
names to Jews, probably at the end of the eighteenth century (so that we
would no longer be Jacob-son-of-David, or Jacob-Mordecai-of-Ryminov), a
state official, seeing thousands of baby chicks running around the family
property, according to family lore, gave us the name Neugeboren, meaning,
in German, "newly born."
Dr. Hashim says something about the appropriateness of my
name, and then, to my surprise, reaches down, lifts the bedsheet, and
takes my hand in his.
"Twenty or so years ago," he says, "I could not have done
anything for you."
Phil Yarnell, with whom I've been talking regularly, and who has
been offering me diagnoses by phone and conferring with Rich and Jerry
about me, telephones from Denver. Phil started out as a neurosurgeon but
switched to neurology early in his career. Before moving to Denver and
becoming chief of neurology at Denver General Hospital and of the
Neuroscience Division at St. Anthony's Hospital there, he taught at the
University of California at Davis; since 1993, in addition to being in private
practice, he has been clinical professor of neurology and neurosurgery at
the University of Colorado School of Medicine.
Phil grew up on the same block in Brooklyn where I lived until I
was two years old — across from Prospect Park — and though neither Phil
nor I have clear memories of having done so, we like to imagine we played
together back then: in front of our apartment houses, in the park, and in the
sandbox and on the monkey bars in the playground that was directly
across from my parents' building.
Phil moved to Denver in 1971, the same year I moved to
Northampton, and has lived there ever since. He and his wife Barbara also
own a 160-acre ranch in Kiowa ("That's one-quarter the size of Prospect
Park," Phil says), a small town an hour east of Denver, where they keep
cows, horses, and llamas. At a lean five-foot-ten-inches tall, with a full head
of white hair and a broad white mustache, and wearing a bolo tie at home
and at work, Phil could pass for sheriff of a Western frontier town. His accent
and blunt, slangy way of talking about things, however, remain pure Brooklyn.
He tells me he was surprised to hear from Jerry that I have heart
disease and that it is so far advanced, but he's glad I'm in Jerry's hospital,
where Jerry can keep an eye on things. This, he says, is very important,
agreeing with why Rich and Jerry have decided upon Yale instead of
Massachusetts General, where Rich originally wanted to send me. Given
the routine and often lethal miscommunications and other slip-ups that prevail
in hospitals, Jerry wanted me at Yale, where he could monitor matters and
where doctors and staff involved in my care would be accountable to him.
My friends had seen a lot of hospitals and doctors, and until you
had, they said, you could not believe the difference there was between
excellent care and care that was less than excellent. It was, more
frequently than anyone dared acknowledge publicly, the difference between
life and death. (And this was ten months before revelations appeared in front
page articles around the country, based upon a report from the Institute of
Medicine of the National Academy of Sciences, that as many as
ninety-eight thousand Americans die every year in hospitals from preventable
medical errors — a figure Rich thought grossly underestimated the
reality. "That figure is just the tippity-tip of the iceberg," Rich said, "and
includes only the most gross and undeniable errors.")
Early that evening my son Eli arrives (Aaron arrives an hour or so
later), and while he is with me another old friend from Erasmus, Arthur
Rudy, calls. I considered Arthur my closest friend in high school and have
been talking with him regularly in recent weeks. Eli, who remains close with
many of his high school friends, says something about how lucky I am to
have remained friends with guys like Arthur — smart, successful, menschy
guys who grew up rooting for the Dodgers and who have turned out to be
delightfully quirky: Where's the downside? he asks.
Arthur was vice president of Erasmus when we were juniors and,
when we were seniors, in a class of more than twelve hundred students,
was voted Boy-Most-Likely-to-Succeed. (Jerry Friedland was elected our
senior class president.) Arthur, too, is a doctor, though not an M.D. He is a
psychologist, formerly chief of psychology at Roosevelt Hospital in New
York City and now in private practice. He tells me that Jerry called him with
the news. Jerry and Arthur, good friends at Erasmus, roomed together for a
year in an Upper West Side apartment during our college years (the three of
us went to Columbia together), and though both acknowledge they made
lousy roommates, they have remained close friends ever since. (Arthur was
best man at Jerry and Gail's wedding.) Arthur and I talk for a while, and — as
with Phil, Jerry, and Rich — though I'm happy to have him calling to wish me
well, what pleases more than anything we say is the knowledge that, before
and after our talk, he, Rich, Jerry, and Phil will be talking with one another
about me. How's Neugie doing? I hear them ask. And: The Neug seemed in
such great shape, and things seemed to be going so well for him . . .
Given that, unlike my four friends, I have been living without a wife
or companion for the past dozen years, the thought that while I am asleep
in the operating room, my chest open and my heart disconnected, these four
guys who have known me, and one another, for nearly a half century will be
taking care of whatever needs to be taken care of, provides more than
comfort. Largely because I cannot know but can only imagine what they will
think, feel, and say, my sense of their concern and affection enables me,
even before my heart is emptied of blood, to see myself in a life that will be
mine after my heart is repaired. Among other pleasant fantasies, I picture
myself at Miriam's wedding, scheduled eight months hence; and, too, I
watch myself at my desk, alone in my third-floor office after my return home,
going through notes and sketching out scenes for a new novel.
Now, and later on during my recovery, when I once again rely on
these friends to get me through matters both medical and personal, I will
find myself seeing us as boys, back again in Brooklyn and doing what we
loved most of all: playing basketball. I see us in our favorite place — Holy
Cross schoolyard on Church Avenue — and I imagine that we are a team:
Phil and Jerry at the forwards, Rich (who is six-foot-two and played college
basketball and baseball) at center, me and Arthur (who once scored 59
points in a league game when he was thirteen) in the backcourt. Four
Doctors and Neugie, I think — five pretty good ballplayers ready to take on all
comers: five guys who loved nothing more than to be away from our homes,
sweating it out on a baseball field, or in a gym, or a fenced-in schoolyard —
five guys who loved nothing more, win or lose, than to hang out together
afterward, talking and laughing about shots made and missed, about passes
threaded and passes gone wild, about girls we were going out with or dreamt
of going out with — five guys who would have loved nothing more than to have
gone on talking forever about those things — sports, girls, the Erasmus
basketball team, and the Brooklyn Dodgers chief among them — that
mattered most in the world to us in those days.

The next morning I telephone my brother Robert, who has been a patient in
state mental hospitals for most of the last thirty-seven years and for whom
I've been primary caretaker. I tell him (and the chief of psychology at Bronx
Psychiatric Center, where Robert is this time) about the surgery. Robert is
silent for a few seconds, then asks if my children will be at the hospital and
who will be taking care of me at home after the operation. He says he will
say a prayer for me.
Miriam and Seth arrive in the morning and, with Eli and Aaron,
stay with me until I am taken to the operating suite. According to them, the
last thing I say before I am wheeled away is that they should use my credit
card when they go out for lunch.
The surgery lasts six and a half hours, and my heart is stopped,
my blood processed through a heart-lung machine (during what physicians
refer to as "pump-time") for one hour and fifty-five minutes. Dr. Hashim and
his team perform a quintuple bypass (five grafts, one more than planned;
when I tell this to Arthur, he laughs: "You were always an overachiever," he
says), and there are no complications. When Rich calls after he has
received faxes of Dr. Hashim's postoperative report, he is very pleased and
tells me the surgeon was absolutely first-rate. But that's based on his own
report, I say. How do you know how good he was? "Several things — but
most of all, the pump-time," Rich replies, referring to the amount of time my
heart was detached and my blood cycled through a heartlung machine. "One
hour and fifty-five minutes for five grafts is incredible. The man is terrific."
When I wake the next day, tubes and wires protruding from my
chest, stomach, arms, neck, and mouth, my children and Seth are there,
and I am able to get out of bed and take a walk with them along the hospital
corridor. I feel very sleepy — and very happy. I fade in and out, and at noon
I watch a nationally televised UMass basketball game. I have taught at the
University of Massachusetts as writer-in-residence since 1971, and for most
of those years my children and I have had season tickets to UMass games.
We have also traveled to other cities — Albany, Worcester, Boston,
Philadelphia, Washington, D.C. — to see games, and our home, where my
friends and my children's friends would gather when the UMass team was
on TV, was dubbed "Hoop Central" by the sports editor of the local
newspaper.
"When I told you the game was on TV," Eli later tells me, "you got
very intense and excited suddenly — as excited as anyone could be, given
where you'd been less than twenty-four hours before. You'd fall asleep
during commercials, but when the game came back on, your eyes would
snap open."
It is only now, the operation over and successful and my children
seeming so happy — and relieved — to be with me (none of us upset, as
we ordinarily would have been, to see UMass lose a crucial end-of-season
league game), that I realize just how frightened they had been, and — but
why the need for such reassurance? — how much they do love me. The
depth of their affection, like that of my friends, seems an unexpected
revelation.
"We were pretty relieved your children were staying with us for the
weekend — and that you weren't," Jerry says. "Your children were lovely,
but they were walking into walls, they were so stunned. I remember that Gail
made this great minestrone soup, with tons of fresh vegetables, and Miriam
warned us that Seth had a very funny, quasi-religious thing about
vegetables — he never ate them — but he just kept spooning the stuff in,
one bowl after the other."
On the afternoon after the UMass game, walking back and forth
by myself from one end of the cardiac care unit to the other while my
children have gone off to eat lunch, and feeling a bit stronger, though still
groggy from the anesthesia and pain medications, I think of how lucky — and
happy! — I am to be alive, of how good it feels simply to be walking ("Listen,
Neugie — keep breathing in and breathing out," Arthur advises. "It's the
secret of staying alive"), and of how dear my children and friends are to me,
and then of how strange, swift, and mysterious the entire experience has
been: of how little we know about how and why I nearly died.

Copyright © 2003 by Jay Neugeboren. Reprinted by permission of Houghton
Mifflin Company.
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Table of Contents

Contents
1 How Little We Know 1
2 All the Time in the World 15
3 The Consolation of Diagnosis 24
4 It's Not Viral, Goddamnit! 49
5 Coronary Artery Bypass Graft Times Five 75
6 The Ponce de León Thing 86
7 Listen to the Patient 102
8 They Saved My Life But . . . 120
9 One Year Later 143
10 In Friends We Trust 158
11 So Why Did I Become a Doctor? 177
12 A Safe Place 199
13 It's Not the Disease 215
14 The Patient's Story 235
15 Natural Selection 267
16 The Prepared Heart 281
Acknowledgments 305
Notes 307
Bibliography 349
Index 353
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First Chapter

1
How Little We Know

On an unseasonably mild, sunny afternoon in early February 1999, I drive
down from my home in Northampton, Massachusetts, to Guilford,
Connecticut, 120 miles away, to spend an evening with my friend Jerry
Friedland and his wife, Gail. Jerry is director of the AIDS programs at Yale–
New Haven Hospital and the Yale School of Medicine, and he and I have
known each other for nearly fifty years — since the fall of 1952, when we
were both sophomores at Erasmus Hall High School in Brooklyn.
Early the next morning I leave my car at Jerry's house and we
head in to Yale–New Haven Hospital together. As I have also been doing for
the past dozen or so years with another high school friend, Phil Yarnell, a
neurologist living in Denver, Colorado, I take a break once or twice a year
from my own work — my writing and teaching — to spend a day with Jerry at
his work.
This time, however, I am traveling with Jerry to New Haven not to
spend a day with him at the hospital and in his AIDS clinic, but because he
has helped arrange an appointment for me with Dr. Henry Cabin, chief of
cardiology at the hospital, to see what's going on in my heart. Dr. Cabin, who
will take an angiogram of my coronary arteries (injecting radio-opaque dye
that makes blockages visible when x-ray pictures are taken), has told me
that this is ordinarily an outpatient procedure. Even if he finds significant
blockages and decides to perform angioplasty (threading balloons into one or
more of my coronary arteries through a catheter to open the arteries), I
should be able to drive back toMassachusetts following the procedure. Still,
Jerry has insisted that I return home with him afterward and stay another
night so I can rest up, and so we can have more time together.
Being with Jerry while he works with patients, staff, and medical
students and talking with him about his work have given me great pleasure
through the years — have inspired me, really. Jerry is one of my oldest and
dearest friends; he is also a doctor whose work with AIDS patients and AIDS
research has been literally life-changing and life-saving for thousands of
people.
When we spend time together between my visits to Yale–New
Haven, we continue the dialogues begun there — discussing patients I've met
and how they're doing, talking about his AIDS research and his public health
projects, and — as in my ongoing talks with Phil — moving from the
particular to the abstract and back again while speculating on the causes,
prevention, diagnosis, and treatment of disease in general — about where, in
things medical, we've been, about where we are, and about where we might
be going.
Also, a true joy, knowing each other as we do across most of our
lives, our talks have meandered — inevitably, always — along more personal
paths as, without needing to impress or dissemble, we've tried, in matters
having to do with things more private — family and friends, above all — to
understand just who we've been, who we are, and where we might, in the
years ahead, be going. When we are together, the time between visits —
whether days, months, or years — disappears. Our conversations, at sixty,
are as warm and stimulating — as rich, delightful, and filled with laughter —
as were our conversations nearly a half century ago when we were teenagers
taking walks together along Flatbush Avenue in Brooklyn.
At the hospital, Jerry walks me through admissions, and, although
he regularly puts in seventy-to-eighty-hour workweeks (Gail maintains this is
a very low estimate), he seems to have nothing else to do but to be with me,
and he stays with me until I am in the room where the angiography is to be
performed. Later on he will recall how astonished he was to find that when I
undressed to ready myself for the procedure, I had to roll up my clothes and
place them on the floor in a corner of the room. If I hadn't been his friend, he
said, he might not have noticed, and this was a reminder to him of how
different things often seem, and are, from a patient's perspective.
When I wake from anesthesia a few hours later, I'm lying on a
gurney, and Dr. Cabin is smiling down at me. Although Dr. Cabin is a decade
or so younger than we are, he too grew up in Brooklyn, where both his
parents were high school teachers, and this, along with his warm, direct
manner, puts me at ease. He has straight dark brown hair, is about five-foot-
nine — two inches taller than me — and is fit and athletic-looking. I look up
at him, my head a bit woozy, and he looks familiar suddenly, like one of the
guys I played schoolyard ball with in Brooklyn.
'Let me show you what we found,' he says.
He points to a monitor hanging above me and explains that what I
am seeing is film from the taken of my heart. The lines of colored fluid
moving downward and outlining my coronary arteries — bourbon-colored
squiggles, in my memory — come from the dye injected through a catheter
he had inserted into the femoral artery in my groin.
On the screen I watch blood begin to flow into each of my three
major coronary arteries, then stop. Dr. Cabin points to the spot where only a
small amount of fluid continues to leak downward and says the angiogram
tells us that only one of my three major coronary arteries is working and that
no more than 10 percent of that artery is functional. Two of my three major
coronary arteries (the right coronary artery and the circumflex artery) are 100
percent blocked, the third (the left anterior descending artery) 90 percent.
Dr. Cabin estimates my ejection fraction, which measures the
heart's ability to pump blood and which is the best general indicator of the
heart's overall functioning, at 30 to 35 percent; in a healthy heart, it would be
between 50 and 70 percent.
'You've been going on nothing,' Dr. Cabin says to me, and
then: 'We're going to try to get you into surgery tomorrow morning.'
'Great,' I say without missing a beat, and it is only later that Jerry
makes me aware that my reaction — Hey, this is good news, so let's go for
it and do whatever we have to — is not typical. At the same time, I am, if
optimistically, in a daze. I hear everything Dr. Cabin says to me but still
seem to believe that in an hour or so I'll walk out of the hospital with Jerry,
get into his car, and drive back to Guilford. Instead of spending an evening
with Je however, I may instead — the possibility seems an ordinary piece
of information — get to spend my last evening on earth alone in a hospital
room in New Haven.
Dr. Cabin tells me that because the arterial occlusions are so
massive, I am going to need a quadruple coronary bypass. (Like a bypass
that reroutes cars and trucks around an avenue clogged with traffic, a
coronary bypass graft, stitched in above and below an obstructed artery,
reroutes blood through an unclogged artery and around the obstructed
artery.) He tells me that he is putting me on several medications to minimize
the possibility of a heart attack, that he has already conferred with Jerry
about surgery, and that he has put a call in to Dr. Sabet Hashim, the man he
and Jerry consider the best cardiovascular surgeon at Yale. If Dr. Hashim
cannot arrange to operate the following morning, a Friday, I will stay in the
hospital over the weekend so that Dr. Cabin and his staff can keep an eye on
me. The slightest exertion — or no exertion at all — might cause some
arterial plaque to flake off, or to rupture, and block the narrow portion of my
one coronary artery that is still working.
Open-heart surgery (or, more accurately, open-chest surgery) is, I
know, a major event, a procedure that seems as astonishingly primitive as it
is technically remarkable: They will crack open my chest then slice open an
arm and a leg to harvest a vein and an artery that, after they shut down my
heart for several hours while recycling my blood through a heart-lung
machine, they will stitch into my heart before reattaching major incoming and
outgoing arteries, jumpstarting my heart with electricity, and stapling and
sewing my chest closed. Even though I will be virtually dead for several
hours — my body temperature lowered to 80 degrees (as with hibernating
animals, cooling reduces the body's need for oxygen, thereby giving the
surgeon extra time for suturing) while a team of doctors and technicians
retrofit me with new interior plumbing made up of spare parts taken from
within my own body — the procedure itself, for all the drama and miracle of
the fact that one can perform it on living human beings, has become
commonplace. Hundreds of thousands of bypasses are performed each year
(more than a half million in the United States), and — given my state of
health — the possibility of failure, error, or distressing side effects seems
minimal.
Dr. Cabin talks with me about the surgery, and I ask if he was
surprised to discover that my arteries are nearly 100 percent blocked.
'No. Little in my line of work surprises me,' he says, and he
adds — something he will repeat when I see him for a six-week checkup
following surgery — 'But you are totally anomalous.'
True enough, I think, for despite the extent of the blockage, I have
had few of the symptoms that usually accompany severe coronary disease:
no chest pain or discomfort (no heaviness, pressure, tightness, or squeezing
sensation), and no arm pain, dizziness, nausea, palpitations, faintness, or
unusual fatigue. Luckier still, especially given the magnitude of the blockage,
I do not seem, on the evidence of an echocardiogram, to have had a heart
a do I seem to have had any of the classic risk factors for
coronary disease. Until a week or so before surgery, I was swimming a mile
a day, and at a good pace, as I had been doing for the previous twenty-five
years, while also regularly playing tennis and half- and full-court basketball
(sometimes with teenagers). I had never been a smoker, my cholesterol was
normal, and so was my blood pressure.
My resting pulse was fifty-eight. By all accounts I was in excellent
physical shape and, at five-foot-seven and 150 pounds, I weighed perhaps 5
pounds more than I had forty-four years before when I was a senior in high
school.
Genetics and family history? My mother was still alive at the age
of eighty-seven, most of my thirteen aunts and uncles had lived well into their
eighties, and some had survived into their nineties. My father, who died of
emphysema at the age of seventy-two, had had a heart attack when he was
fifty-nine, but he never exercised, had been overweight, and had smoked
three packs of Chesterfields a day throughout his adult life.
About an hour after my talk with Dr. Cabin, when I've been moved
to a hospital room and am lying in bed — the first time I've been hospitalized
since I was operated on for Hodgkin's disease at the age of eighteen, forty-
two years earlier — Jerry comes by to visit.
'Hey Neugie,' he says, using the nickname all my old friends
use. 'How're you feeling?'
I tell him I'm feeling a little groggy, and very lucky — lucky they
found what they found and that, as I've just learned, they can get me into
surgery in the morning. (Later, Jerry and Gail tell felt lucky too,
since Dr. Cabin had suggested that if Dr. Hashim was unable to perform the
surgery on Friday they might take me home for the weekend. 'Oh my God —
what do I remember about CPR?' Gail, a registered nurse, asked Jerry when
he told her of this possibility.)
Jerry tells me that after Dr. Cabin saw the results of the
angiography, he had paged Jerry and they had discussed what to do next.
Jerry says that he was surprised — very much so — at what the angiogram
revealed, but that he is pleased to learn that Dr. Hashim will be performing
the surgery in the morning. The sooner the better, he says, and he tells me
that my swimming and being in such good shape have probably saved my life.
'It seems you've been living on your collaterals,' Jerry says, and
he explains that the collateral blood vessels I'd probably developed by
swimming a mile a day for the past twenty-five years — hundreds of small
steady-state blood vessels that lie between and connect the coronary
arteries and that cannot expand and contract the way coronary arteries
can — had been supplying the blood and oxygen to my heart and lungs that
my coronary arteries were no longer providing.
Jerry then describes what he saw on the monitor. 'A second or
two after the blood stopped flowing into your heart, the entire bottom of the
TV screen — the lower part of your heart — lit up, just blossomed with the
glow of all those collateral blood vessels,' he says. 'It was an amazing sight.'
We talk about telling my three children about the surgery, and this
gives me pause — unsettles me for since I arrived at the
hospital. For a full half minute or more I cannot speak. Jerry smiles down at
me. He is a strikingly handsome man, five-foot-eleven and about two hundred
pounds, with a trim silver beard, a full and wavy shock of silver hair, and
penetrating gray eyes that remind me of Jewish actors such as John Garfield
and Paul Newman who have had the same captivating mix, in their looks, of
toughness, intelligence, savvy, and tenderness. When, seeing my reaction,
Jerry puts his hand on top of mine, I melt. Is this it? I wonder. Is the big
basketball in the sky really about to fall on me?
Although Jerry's presence comforts, it is also sobering, since he
does not hide the seriousness of his concern, and when he asks if I would
like him to call my children, I shake my head sideways and see myself, a
small boy again, sitting on the floor of my office at home, sorting through my
baseball cards and glancing up now and then toward my desk, where the
light is on but nobody is working.
For more than a dozen years, I have been a single parent to my
three children. By this time, however, the last of my children having left home
the previous spring, I am, for the first time in three decades, no longer an on-
site single parent. All three have graduated from college and are living on their
own: Miriam, at twenty-nine, in the Washington, D.C., area; Aaron, at twenty-
six, in Northampton; and Eli, at twenty-four, in Brooklyn, not far from where I
was born and from where Jerry and I grew up.
I had told each of my children about driving down to New Haven for
the angiogram but, not wanting to alarm or burden them, h minimized its
importance: everything seemed fine, I'd said, and I was still swimming a mile
a day, but some anomalies had shown up on an electrocardiogram, and we
thought it best to check things out further, so I'd decided to have an
angiogram performed at Yale–New Haven. That way, I explained, I could also
spend some time with Jerry.
When I find my voice, I tell Jerry that I'll telephone my children.
Jerry says that he'll call them also and that they can stay at his house (into
which he and Gail moved two weeks before) for as long as they want.
Jerry also tells me he's spoken with Rich Helfant and that Rich
agrees about the need for emergency bypass surgery. Rich, too, is an old
high school friend, and I've known him even longer than I've known Jerry,
since, starting from a time when we were seven or eight years old, Rich and I
went to the same Hebrew School (we later played together on our
synagogue's basketball team). Rich is a cardiologist now living in California —
most recently he served as chief of cardiology at Cedars–Sinai Medical
Center in Los Angeles; before that he was director of the Philadelphia Heart
Institute and chief of medicine and cardiology at Presbyterian-University of
Pennsylvania Medical Center — and these past few weeks he and I have
been talking nearly every day. In the week to ten days preceding the
angiogram, a fact I found both welcome and disquieting, he had been calling
me several times each day.
Later that afternoon Rich calls and says he is not at all surprised
at what the angiogram revealed and that, based on his talks with Jerry, he
h confidence in Dr.Hashim and the people at Yale. He reminds me
that he had been urging me into the hospital — gently, gently, so as not to
scare me — for several weeks.
When my family practitioner, while not excluding the possibility of
coronary disease, thought the symptoms that had made me call for an
appointment — some occasional shortness of breath while swimming —
were due to adult-onset or exercise-induced asthma, and when a local
cardiologist, finding some anomalies in an electrocardiogram and an
echocardiogram, while also not excluding coronary disease, thought the
problem was probably viral, Rich had exploded. 'It's not viral, goddamnit!' he
had exclaimed, in the first burst of exasperation I'd heard from him since I'd
begun talking with him about my concerns. 'I want you in the hospital as
soon as possible.'
The local cardiologist had recommended that I have an angiogram
done at Bay State Hospital in Springfield, but when I called his office to make
an appointment, the colleague who performed the angiograms was booked for
several weeks. I was persistent and secured a 'brief office visit' a week later,
not for the angiogram, but to confer about setting up an appointment for the
angiogram. Then I had telephoned Rich, Jerry, and Phil.
'Listen,' I'd said to Rich, as I had to Jerry the day after I'd received
the results of the EKG and the echocardiogram, 'why don't you guys all talk
with one another and then just tell me what to do?'
On Sunday morning, Jerry phoned to say that he and Rich had
decided I should come down to Yale and that Dr. Cabin would be calling me
at he did) to arrange for the angiogram.
Now, less than a week later, Rich says that, barring the
unforeseen, he feels certain that the bypass surgery and the recovery from
the surgery will go swiftly and smoothly. He asks about my children, and I
tell him I've spoken with each of them and that they will all be arriving at the
hospital before surgery the next morning.
Aaron is already on his way down from Northampton by bus; Eli is
on his way from New York City by train; and Miriam and her fiancé Seth will
be taking a three a.m. train from Washington, D.C., and will arrive early the
next morning. I tell Rich I was surprised that they didn't hesitate, and will be
with me — I note that I didn't ask any of them to come — and Rich tells me
he is surprised that I was surprised. Why wouldn't my children want to be
with me at a time like this?
After supper, Dr. Hashim stops by and talks with me for a while.
Dr. Hashim is Lebanese and therefore, I expect, speaks French. I tell him I
lived in France for two years some thirty years ago, before and after my first
child, Miriam, was born, and Dr. Hashim and I proceed to talk with each other
in both French and English. Although he describes the surgery and explains
the possible risks attendant to it, such as stroke, retinal damage, cognitive
losses, and infection, and says that, given the excellent state of my health,
he sees no cause for concern, it is our conversation about things ordinary
and familial that calms my fears and reassures.
When I comment on his name and its possible biblical origin, he
tells me that yes, he believes he is a desce families that inhabited
the ancient Hashemite kingdom. He asks about my name and I tell him my
father's family came from Ryminov, a shtetl in the Carpathian Mountains —
from a region now part of Ukraine — and that they had been in the butter-and-
egg business there, as they were after they came to the United States.
When, in the Austro-Hungarian Empire, civil servants assigned family names
to Jews, probably at the end of the eighteenth century (so that we would no
longer be Jacob-son-of-David, or Jacob-Mordecai-of-Ryminov), a state official,
seeing thousands of baby chicks running around the family property,
according to family lore, gave us the name Neugeboren, meaning, in
German, 'newly born.'
Dr. Hashim says something about the appropriateness of my
name, and then, to my surprise, reaches down, lifts the bedsheet, and takes
my hand in his.
'Twenty or so years ago,' he says, 'I could not have done
anything for you.'
Phil Yarnell, with whom I've been talking regularly, and who has
been offering me diagnoses by phone and conferring with Rich and Jerry
about me, telephones from Denver. Phil started out as a neurosurgeon but
switched to neurology early in his career. Before moving to Denver and
becoming chief of neurology at Denver General Hospital and of the
Neuroscience Division at St. Anthony's Hospital there, he taught at the
University of California at Davis; since 1993, in addition to being in private
practice, he has been clinical professor of neurology and neurosurgery at the
University of Colorado School of Medicine.
Phil grew up on the same block in Brooklyn where I lived
was two years old — across from Prospect Park — and though neither Phil
nor I have clear memories of having done so, we like to imagine we played
together back then: in front of our apartment houses, in the park, and in the
sandbox and on the monkey bars in the playground that was directly across
from my parents' building.
Phil moved to Denver in 1971, the same year I moved to
Northampton, and has lived there ever since. He and his wife Barbara also
own a 160-acre ranch in Kiowa ('That's one-quarter the size of Prospect
Park,' Phil says), a small town an hour east of Denver, where they keep
cows, horses, and llamas. At a lean five-foot-ten-inches tall, with a full head
of white hair and a broad white mustache, and wearing a bolo tie at home and
at work, Phil could pass for sheriff of a Western frontier town. His accent and
blunt, slangy way of talking about things, however, remain pure Brooklyn.
He tells me he was surprised to hear from Jerry that I have heart
disease and that it is so far advanced, but he's glad I'm in Jerry's hospital,
where Jerry can keep an eye on things. This, he says, is very important,
agreeing with why Rich and Jerry have decided upon Yale instead of
Massachusetts General, where Rich originally wanted to send me. Given the
routine and often lethal miscommunications and other slip-ups that prevail in
hospitals, Jerry wanted me at Yale, where he could monitor matters and
where doctors and staff involved in my care would be accountable to him.
My friends had seen a lot of hospitals and doctors, and until you
had, they said, you could not believe the difference there between
excellent care and care that was less than excellent. It was, more frequently
than anyone dared acknowledge publicly, the difference between life and
death. (And this was ten months before revelations appeared in front page
articles around the country, based upon a report from the Institute of
Medicine of the National Academy of Sciences, that as many as ninety-eight
thousand Americans die every year in hospitals from preventable medical
errors — a figure Rich thought grossly underestimated the reality. 'That figure
is just the tippity-tip of the iceberg,' Rich said, 'and includes only the most
gross and undeniable errors.')
Early that evening my son Eli arrives (Aaron arrives an hour or so
later), and while he is with me another old friend from Erasmus, Arthur Rudy,
calls. I considered Arthur my closest friend in high school and have been
talking with him regularly in recent weeks. Eli, who remains close with many
of his high school friends, says something about how lucky I am to have
remained friends with guys like Arthur — smart, successful, menschy guys
who grew up rooting for the Dodgers and who have turned out to be
delightfully quirky: Where's the downside? he asks.
Arthur was vice president of Erasmus when we were juniors and,
when we were seniors, in a class of more than twelve hundred students, was
voted Boy-Most-Likely-to-Succeed. (Jerry Friedland was elected our senior
class president.) Arthur, too, is a doctor, though not an M.D. He is a
psychologist, formerly chief of psychology at Roosevelt Hospital in New York
City and now in private practice. He tells me that Jerry cal him with the
news. Jerry and Arthur, good friends at Erasmus, roomed together for a year
in an Upper West Side apartment during our college years (the three of us
went to Columbia together), and though both acknowledge they made lousy
roommates, they have remained close friends ever since. (Arthur was best
man at Jerry and Gail's wedding.) Arthur and I talk for a while, and — as with
Phil, Jerry, and Rich — though I'm happy to have him calling to wish me well,
what pleases more than anything we say is the knowledge that, before and
after our talk, he, Rich, Jerry, and Phil will be talking with one another about
me. How's Neugie doing? I hear them ask. And: The Neug seemed in such
great shape, and things seemed to be going so well for him . . .
Given that, unlike my four friends, I have been living without a wife
or companion for the past dozen years, the thought that while I am asleep in
the operating room, my chest open and my heart disconnected, these four
guys who have known me, and one another, for nearly a half century will be
taking care of whatever needs to be taken care of, provides more than
comfort. Largely because I cannot know but can only imagine what they will
think, feel, and say, my sense of their concern and affection enables me,
even before my heart is emptied of blood, to see myself in a life that will be
mine after my heart is repaired. Among other pleasant fantasies, I picture
myself at Miriam's wedding, scheduled eight months hence; and, too, I watch
myself at my desk, alone in my third-floor office after my return home, going
through notes and sketching out scenes for a ne novel.
Now, and later on during my recovery, when I once again rely on
these friends to get me through matters both medical and personal, I will find
myself seeing us as boys, back again in Brooklyn and doing what we loved
most of all: playing basketball. I see us in our favorite place — Holy Cross
schoolyard on Church Avenue — and I imagine that we are a team: Phil and
Jerry at the forwards, Rich (who is six-foot-two and played college basketball
and baseball) at center, me and Arthur (who once scored 59 points in a
league game when he was thirteen) in the backcourt. Four Doctors and
Neugie, I think — five pretty good ballplayers ready to take on all comers: five
guys who loved nothing more than to be away from our homes, sweating it
out on a baseball field, or in a gym, or a fenced-in schoolyard — five guys
who loved nothing more, win or lose, than to hang out together afterward,
talking and laughing about shots made and missed, about passes threaded
and passes gone wild, about girls we were going out with or dreamt of going
out with — five guys who would have loved nothing more than to have gone on
talking forever about those things — sports, girls, the Erasmus basketball
team, and the Brooklyn Dodgers chief among them — that mattered most in
the world to us in those days.

The next morning I telephone my brother Robert, who has been a patient in
state mental hospitals for most of the last thirty-seven years and for whom
I've been primary caretaker. I tell him (and the chief of psychology at Bronx
Psychiatric Center, where Robert is this time) about the surgery. Robert is
silent for a few seconds, then asks if my children will be at the hospital and
who will be taking care of me at home after the operation. He says he will
say a prayer for me.
Miriam and Seth arrive in the morning and, with Eli and Aaron,
stay with me until I am taken to the operating suite. According to them, the
last thing I say before I am wheeled away is that they should use my credit
card when they go out for lunch.
The surgery lasts six and a half hours, and my heart is stopped,
my blood processed through a heart-lung machine (during what physicians
refer to as 'pump-time') for one hour and fifty-five minutes. Dr. Hashim and
his team perform a quintuple bypass (five grafts, one more than planned;
when I tell this to Arthur, he laughs: 'You were always an overachiever,' he
says), and there are no complications. When Rich calls after he has received
faxes of Dr.
Hashim's postoperative report, he is very pleased and tells me the
surgeon was absolutely first-rate. But that's based on his own report, I say.
How do you know how good he was? 'Several things — but most of all, the
pump-time,' Rich replies, referring to the amount of time my heart was
detached and my blood cycled through a heartlung machine. 'One hour and
fifty-five minutes for five grafts is incredible. The man is terrific.'
When I wake the next day, tubes and wires protruding from my
chest, stomach, arms, neck, and mouth, my children and Seth are there,
and I am able to get out of bed and take a walk with them along the hospital
corridor. I feel very sleepy — and very happy. I fade in and out, and a nationally televised UMass basketball game. I have taught at the
University of Massachusetts as writer-in-residence since 1971, and for most
of those years my children and I have had season tickets to UMass games.
We have also traveled to other cities — Albany, Worcester, Boston,
Philadelphia, Washington, D.C. — to see games, and our home, where my
friends and my children's friends would gather when the UMass team was on
TV, was dubbed 'Hoop Central' by the sports editor of the local newspaper.
'When I told you the game was on TV,' Eli later tells me, 'you got
very intense and excited suddenly — as excited as anyone could be, given
where you'd been less than twenty-four hours before. You'd fall asleep during
commercials, but when the game came back on, your eyes would snap
open.'
It is only now, the operation over and successful and my children
seeming so happy — and relieved — to be with me (none of us upset, as we
ordinarily would have been, to see UMass lose a crucial end-of-season
league game), that I realize just how frightened they had been, and — but
why the need for such reassurance? — how much they do love me. The
depth of their affection, like that of my friends, seems an unexpected
revelation.
'We were pretty relieved your children were staying with us for the
weekend — and that you weren't,' Jerry says. 'Your children were lovely, but
they were walking into walls, they were so stunned. I remember that Gail
made this great minestrone soup, with tons of fresh vegetables, and Miriam
warned us that Seth had a very funny, quasi-religious thing a
vegetables — he never ate them — but he just kept spooning the stuff in, one
bowl after the other.'
On the afternoon after the UMass game, walking back and forth
by myself from one end of the cardiac care unit to the other while my children
have gone off to eat lunch, and feeling a bit stronger, though still groggy from
the anesthesia and pain medications, I think of how lucky — and happy! — I
am to be alive, of how good it feels simply to be walking ('Listen, Neugie —
keep breathing in and breathing out,' Arthur advises. 'It's the secret of
staying alive'), and of how dear my children and friends are to me, and then
of how strange, swift, and mysterious the entire experience has been: of how
little we know about how and why I nearly died.

Copyright © 2003 by Jay Neugeboren. Reprinted by permission of Houghton
Mifflin Company.
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  • Anonymous

    Posted September 8, 2003

    Listen to the patient

    In this age of sophisticated medical tests many physicians no longer listen to or even examine their patients. Jay skillfully recounts his experiences and offers a plea for humanization of medical care. It is a warm, touching and somewhat frightening story which I highly recommend.

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